HHS Releases Additional Rules on Exchanges

Three proposed rules that the Department of Health and Human Services (HHS) issued on Friday aim to provide a simple, streamlined, and affordable path for consumers to purchase private health insurance through Health Insurance Exchanges ("Exchanges").

Specifically, the rules establish eligibility determinations for Exchange participation and insurance affordability programs and standards for employer participation in the Small Business Health Options Program (SHOP). Small employers participating in SHOP will be able to offer their employees a choice of health plans and cut their costs with new tax credits. Additionally, individuals and families will receive premium tax credits to help defray insurance costs. The rules also propose coordinating Exchanges with Medicaid and Children's Health Insurance Program eligibility, making enrollment seamless for qualified Americans and reducing the administrative burden on states.

Also on Friday, HHS awarded 13 states and the District of Columbia more than $185 million dollars in Exchange Establishment grants. To date, 49 states and the District of Columbia have received Exchange Planning grants, and 7 states received Early Innovator grants. A number of states have indicated interest for future rounds of Exchange Establishment grants.

APTA will provide a more detailed summary of the proposed rule shortly.

In July, HHS released the first of its proposed rules on the Exchanges. Comments on that proposal are due September 10. The Exchanges will become operational January 1, 2014.

Comments

Why are Physical Therapists in Private Practice (at least) not included in EHR Incentive Program???
Who is an Eligible Professional under the Medicare EHR Incentive Program?
Eligible professionals under the Medicare EHR Incentive Program include:
Doctor of medicine or osteopathy
Doctor of dental surgery or dental medicine
Doctor of podiatry
Doctor of optometry
Chiropractor
Who is an Eligible Professional under the Medicaid EHR Incentive Program?
Eligible professionals under the Medicaid EHR Incentive Program include:
Physicians (primarily doctors of medicine and doctors of osteopathy)
Nurse practitioner
Certified nurse-midwife
Dentist
Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.
To qualify for an incentive payment under the Medicaid EHR Incentive Program, an eligible professional must meet one of the following criteria:
Have a minimum 30% Medicaid patient volume*
Have a minimum 20% Medicaid patient volume, and is a pediatrician*
Practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals
· Children's Health Insurance Program (CHIP) patients do not count toward the Medicaid patient volume criteria.